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Why Having One Certification Board Makes Sense

Wednesday, 09/22/10 | 29863 reads

Ron Raducanu DPM FACFAS

I really enjoy reading. I read as much as I can get my hands on. For pleasure reading, I tend to favor political thrillers or any type of grab you by the throat type stories that get my attention from the get-go.

I also like to write (as you can imagine). Not only do I write this blog, I also write for the American Podiatric Medical Association (APMA) Young Members’ Exchange. I have been working on an autobiographical account of my experiences throughout my younger years and why I decided to go into medicine as well as my experiences in podiatry school and beyond. It is a work in progress but very cathartic.

Several years ago, I sat in on a Council on Podiatric Medical Education (CPME) meeting at the Annual Scientific Meeting of the APMA, for the residency director of our local residency program. The topic of Vision 2015 came up and the overwhelming question was how this would affect the boards and the APMA Affiliates with regard to mergers and having single organizations representing us as a profession. Since that meeting, I have been following all of these issues very closely and reading as much as is available about this topic. Very recently, I came across a very exciting bit of news in the APMA Young Members’ Exchange that may speak to this.

What About New Merger Talks Between ABPOPPM And ABPS?

It seems that years ago there was some discussion on the merits of merging the American Board of Podiatric Orthopedics and Primary Podiatric Medicine (ABPOPPM) and the American Board of Podiatric Surgery (ABPS). For whatever reason, these talks bore no fruit and the potential of these two organizations merging and offering just one board certification sanctioned by the APMA went by the wayside.

It appears that these merger talks have resumed and I believe this is a very exciting prospect. In the community I practice in, if you do not have ABPS certification, you will eventually not be able to practice in the hospital setting. This effectively leaves out some of my colleagues. I think this hurts more than it helps.

If we had only one certification body, these issues would virtually disappear. Rather than being asked if you are board certified, the question here would be “Are you ABPS certified?” I do imagine that this potential merger would meet with a lot of resistance, but in the next five years, with all of our residents getting the training they are getting, wouldn’t it make sense to have one examination and one certification?

Why I Did Not Pursue The ABPOPPM Certification After Residency

Even though I did do a primary podiatric medicine residency (remember those?) before I did my two-year surgical residency, I chose not to pursue the ABPOPPM certification upon graduating from residency for one reason only. I could not afford it.

Back then, I could not justify the expense of traveling (flights, hotel, food), sitting for the test, flying back out for the oral exam and paying more dues. At that time, I knew those credentials would not make much difference for privileging purposes with the hospitals where I was going to practice. Shallow? Maybe, but you do what you have to do. Now the expense is less since you sit for the written test at any test-taking center but it is still a pricey proposition.

I did a tremendous amount of rearfoot reconstructive surgery where I did my residency. Unfortunately, it was not the kind of thing that the ABPS reconstructive rearfoot/ankle (RRA) exam tested. I found this exam exceptionally difficult based on the experience I had in residency and the types of cases I was expected to know for that examination. I was not exposed to the concepts of center of rotation of angulation (CORA) and tibial transpositions and rotations. These concepts comprised quite a large part of the exam that I was eventually unsuccessful in passing.

I had considered retaking the exam. However, in my community, you did not need that certification to get rearfoot privileges. Due to the added expense in retaking the examination and my inexperience with those cases, I decided not to take the examination again.

Has this hurt my practice? No, save for one instance. Even though 50 percent or so of my surgery in private practice is rearfoot focused, no company will train me to do ankle replacement surgery. This is because the companies that offer these devices for implantation require RRA certification in order for you to receive this training. I would like to get trained to do this new procedure but I cannot.

I also think only having one board with one certification will address this as well. I practice in an area, which has a good number of highly skilled, very competent surgeons who were grandfathered to have “foot and ankle” certification, even though they had one year of residency training. I have the utmost respect for these surgeons as they established the foundation for our profession when it comes to surgical and hospital privileges. They deserve every accolade they get.

I just wonder why there has to be such a separation of “certifications.” So are you board certified in foot surgery, rearfoot reconstruction or foot and ankle? Is it all, both, one or neither? I truly believe that with one certification body, our profession can truly start working toward not only unity but parity as well.

Why Having One Board Would Help Streamline Affiliate Groups

This would also trickle down to the affiliate organizations of the APMA in my eyes. I can only speak for myself but keeping an affiliate organization running in this day and age is not an easy endeavor. The expense associated with running one is high compared to the returns. Getting corporate sponsorship with the new federal regulations is virtually impossible. Affiliate groups function thanks to a group of volunteers who get no compensation for their time or efforts but do get the satisfaction of knowing they help us out.

Why not have one APMA Affiliate organization to go with the one board certification? Get certified by one, get a fellowship in the other. The American College of Foot and Ankle Orthopedics and Medicine (ACFAOM) tried this a couple of years ago. Even though the college really did put its best effort forward to make this happen, there were too many unanswered questions and ultimately the merger did not happen.

Now that the APMA has a new surgical affiliate with the American Society of Podiatric Surgeons (ASPS), it is prime time to make this happen to ensure the longevity of all of the organizations and band us together toward a common goal.

In other words, I would like everyone to consider becoming board certified by groups that I propose calling the “American Board of Podiatric Medicine (Orthopedics?) and Surgery” and then apply to become a “Fellow of the American College of Foot and Ankle Medicine (Orthopedics?) and Surgery.” This would also address the growing concern of “we focus too much on surgery” as well as the CPME standards associated with the number of biomechanical examinations performed in residency. I think we can manage that. I would love to hear other perspectives on this.

Comments

There are docs not interested in big surgery. There are many areas of expertise within podiatry. Our profession is immature and obsessed with screws and plates.
Podiatry is over 90 percent conservative care, no doubt about it.

Being a good surgeon is great but is not necessary to practice daily podiatry. When surgery is needed, a referral can be made.

I wonder why there are no boards in diabetic foot, geriatrics, dermatology, etc.?